Park Use Permit - M2L Youth BBQ FundraiserCITY OF OKEECHOBEE
55 SE THIRD AVENUE
OKEECHOBEE, FL 34974
Tele: 863-763-9821 Fax: 863-763-1686
e-mail: idunham a(�cityofokeechobee. com
Park Use Permit
Permit Number: 008
Permit Expiration: June 28, 2019 11:59PM
Purpose of Request: Youth BBQ Fundraiser
Property Owner: City of Okeechobee
Address: 55 SE Third Avenue
City: Okeechobee
Date(s) of Event: June 28, 2019 3:OOAM -. 4:OOPM
State: Florida Zip Code: 34974
Applicant: More 2 Life Ministries, Inc. Applicant's Address: 605 SW Park St Ste 214
Phone Number: 863-467-0796 Address of Project: Park #3
Current Zoning: P FLU Designation: Public
Subdivision: City of Okeechobee
Restrictions/Remarks: All debris must be removed within 24 hours of expiration date.
Clean-up of all garbage from the event including emptying the trash cans in the park(s) used and placing
clean trash can liners in cans after the event.
Ensure emergency vehicles have access to site and fire extinguishers are on site or available nearby.
,_Ta ckc4 e'
May 21, 2019
Administrative Secretary/General Services Date
Jackie Dunham
From: India Riedel
Sent: Tuesday, May 21, 2019 2:43 PM
To: Marcos Montes De Oca; Robin Brock; Melissa Henry; Kim Barnes; Patty Burnette; Jackie
Dunham; Bobbie Jenkins; Lane Gamiotea; Jeff Newell; Herb Smith; Robert Peterson
Cc: India Riedel; Sue Christopher; Terisa Garcia; Kay Matchett; Fred Sterling
Subject: Staff Schedule this week and next
FYI:
I will be out Friday, 5/24 at 11:00 — 4:30
Melissa will be out 5/28 Tuesday
Kim will be out 5/30 Thursday through 6/4 Tuesday
India Riedel
Finance Director
City of Okeechobee
55 SE 3rd Avenue
Okeechobee, FL 34974
Phone: (863) 763-3372
Direct: (863) 763-9818
Fax: (863) 763-1686
NOTICE: Florida has a very broad public records law. As a result, any written communication created or received by the City of Okeechobee
officials and employees will be available to the public and media, upon request, unless otherwise exempt. Under Florida law, e-mail addresses are
public records. If you do not want your e-mail address released in response to a public records request, do not send electronic mail to this
office. Instead, contact our office by phone or in writing.
1
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of o444e
Page 1 of 3
Revised 3-21--17
3- s- ,9
CITY OF OKEECHOBEE
55 SE THIRD AVENUE
OKEECHOBEE, FL 34974
� Tele: 863-763-9821 Fax 863-763-1686
PARK USE AND/OR TEMPORARY STREET/
SIDEWALK CLOSING
PERMIT APPLICATION
0
•'4;olk
„ ,t,
P,•
=_6 - ` - o��•'•
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Date Received:
:5 f r1 r y
Date Issued: .5' -1 -1 i
Application No:
pi -po g
Date(s) & Times of Event: . / 2. Y / I 3 y r,,, — Li r,
Information:
Organization: (Y c, c. `i-- \% c.C1 •n; s t 1A S TN,„ l
�
Mailing Address: (Q S s p ,,L( S-) (<.,-\- S. . L. 1 y v, „, v ,,,ck F L, 3 `) '7 i.
Contact Name: ((
w o,-,N\�
E-Mail Address: NN;qh �• fn 1 L re\ ,r; A z if- _ (4 rl
Telephone:
Work: 1 N, 3 - 9 6) —1 y
Home: Cell: "c Ci - ‘ i- I 1 `J f
Summary of activities:
6!VI rL,L.1i-AAisC:sr--c. 4 Niro_' - To Al-ICA A .6u.rvztvre -- c 4-.1.1,-, 4, --,c-i1 Ii- i nth r q
Proceeds usage:
f4hL i , Ya t...1--/-k. C.c.:o
J
Please check
Flagler
(If other private
parcel number
Additional Addresses,
Parcel ID:
requested Parks:
Parks: o City Hall
[Park 3 is location
property used in
below along with notarized
if applicable
Park o #1 Memorial Park o #2 ❑ #3 o #4 o #5 o #6
of Gazebo. Park 4 is location of Bandstand]
conjunction with this Park Use Permit please provide the address and
letter of authorization from property owner)
Page 2 of 3
Revised 11/4/16
TEMPORARY STREET AND SIDEWALK CLOSING INFORMATION
(Street Closings require City Council approval. Meetings 1St & 3`d Tuesdays but subject to change)
Address of Event:
Street(s) to be closed:
Date(s) to be closed: N
Time(s) to be closed:
Purpose of Closing: '--
Attachments Required for Use of Parks Attachments Required for Street/Sidewalk Closings
► Site Plan
► Site Plan
► Copy of liability insurance in the amount of
$1,000,000.00 with the City of Okeechobee as
additional insured.
► Copy of liability insurance in the amount of
$1,000,000.00 with the City of Okeechobee and R.E.
Hamrick Testamentary Trust as Additional Insured.
► Proof of non-profit status ( ermmation
L,gtte)
► Original signatures of all residents, property owners and
business owners affected by the closing.
State Food Service License if > 3 days.
► State Food Service License if > 3 days.
otarized letter of authorization from
roperty owner, if applicable.*
► State Alcoholic Beverage License, if applicable.**
* Required if private property used in conjunction with a Park Use application.
** Alcoholic beverages can be served only on private property. Alcoholic beverages NOT ALLOWED in City
Parks, City streets or City sidewalks. See additional note below.
❑ Please check if items will be sold on City streets/sidewalks. Each business will need to apply for a Temporary
Use Permit 667 along with the Street Closing application.
Note:
► Clean-up is required within 24 hours.
► No alcoholic beverages permitted on City property, streets or sidewalks.
► No donations can be requested if any type of alcoholic beverages are served on private
property/business unless you possess a State Alcoholic Beverage License. Please note there are inside
consumption and outside consumption licenses. You must have the appropriate license(s).
► The Department of Public Works will be responsible for delivering the appropriate barricades.
► Dumpsters and port -o -lets are required when closing a street for more than three (3) hours.
Applicant must meet any insurance coverage and code compliance requirements of the City and other regulations
of other governmental regulatory agencies. The applicant will be responsible for costs associated with the event,
including damage of property. By receipt of this permit, the applicant agrees and shall hold the City harmless for
any accident, injury, claim or demand whatever arises out of applicant's use of location for such event, and shall
indemnify and defend the City for such incident, including attorney fees. The applicant shall be subject to
demand for, and payment of, all of the actual costs incurred by the City pertaining to the event including, but not
limited to, Police, Fire, Public Works or other departmental expenses. The City reserves the right to require from
an applicant a cashier's check or advance deposit in the sum approximated by the City to be incurred in providing
City services. Any such sum not incurred shall be refunded to the applicant of this Park Use/Street Closing
Permit.
Page 3 of 3
Revised 11/4/16
I hereby acknowledge that I have read and completed this application, the attached Resolutions No.(s) 03-8 and
04-03, concerning the use and the rules of using City property, that the information is correct, and that I am the
duly authorized agent of the organization. I agree to conform with, abide by and obey all the rules and
regulations, which may be lawfully prescribed by the City Council of the City of Okeechobee, or its officers, for
the issuance
Certificate of Insurance must name City of Okeechobee as Additional Insured as well as R.E. Hamrick
Testamentary Trust if closing streets or sidewalks.
C / '\ / \
Applican igna`tur Date
""OFF ; USE ONLY""
Staff Review
Fire Department:(
Date:
,/p'9/t?
41
Building Official:
mir
Date:
,�• I% ' 19
Public Works:/
ice//
Date:
S ^1e
j
Police Department:
Date:
5"2-/
BTR Department:
//!��
91`a_ (
eillillu
Date:
5-10 -19
City Administrator:
Date:
--5172-/i,'
City Clerk:
i CLL( - 0 ili,(eb0,-
Date:
.) / (1( i Ki
NOTE: APPLICATION AND INSURANCE CERTIFICATE MUST BE COMPLETED AND
RETURNED TO THE GENERAL SERVICES DEPARTMENT THIRTY (30) DAYS PRIOR TO
EVENT FOR PERMITTING.
Temporary Street and Sidewalk Closing submitted for review by City Council on
t4/1 -
Date
Temporary Street and Sidewalk Closing reviewed by City Council and approved
FV
Date
i APPLICATI
1 `J 9,
v Application #: J -a) g
N FOR SPECIAL EVENT
Date Submitted: 5// 1 Permit #:
NAME OF EVENT:
G 0- �4,„Y S Hari,<t C %\e'l
ADDRESS OF EVENT: Pc\ rk 3
DESCRIPTION OF EVENT:
N -(.\-o-4(•••
5 WciN"MI (oNtn w 1 y ‘
s \j a ‘4\,
iq
NAME r OF\ SPONSOR
`
a(k. L .2,k �n.r'-(,v tV1(
Contact Number before and during event OF RESPONSIBLE PERSON:
ORGANIZATION:
N 1c3-301
DATE(S) AND TIME(S) OF EVENT:
Date: k. / L' / \ 'N Starting Time: 3 ()A-, Closing Time: 9
Date: Starting Time: Closing Time:
Date: Starting Time: Closing Time:
ARE ANY ROADWAYS TO BE BLOCKED/CLOSED? N fs LOCATION
IF
Will Emergency Apparatus (Fire and Ambulance) have access to area? t,
NO, THEN EXPLAIN (provide alternatives):
WILL ELECTRICITY BE USED? YES gi'❑NO C!
Locations: \' a e 12 3
Provided By: o v 10vr \.)
WILL HEATING/OPEN FLAMES FOR FOOD BE PROVIDED? YES\aisONO ❑
Type of Heating Equipment Used: Is V (%v\ \`, Fi Ai=. L x i w i i 1
be Tei
WILL A TENT BE ERECTED? YES k NO ❑
Tent Manufacturer: Size I ®.)( fire rating posted:
Tent have sides and how many? 1. a t 3 t_0,).1 14 11.
4,1
fSee Fire rding sa#e
***ATTACH SITE MAP OF EVENT LAYOUT***
The following items to be completed by Fire Department only
FIRE DEPARTMENT LIFE SAFETY & FIRE SERVICES REQUIREMENTS: (See above)
O Tents/canopy fire rating certificate required.
O Tent Size require life safety inspection (900 square feet or less then no permit is required)
O Floor plan / seating / setup drawing required showing exits, etc.
O Emergency access must be maintained. (REFERS TO VEHICLES AND EQUIPMENT)
O Fire extinguishers must have current tag, and be operational and readily accessible.
0 Cooking requires LPG outside of tent pointing away from exposures.
O Electrical wiring exterior rated, not overloaded.
O Fire Services inspection required.
O Fire watch or inspector(s) REQUIRED? FIRE WATCH Amount:
O Firefighter/Inspector Amount: O Other:
FIRE DEPARTMENT OFFICIAL (PRINT):
SIGNATURE: Please call the FD at 863-467-1586 for any questions.
maagD
ACC R�® CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
5,92019
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER
Pritchards & Associates, Inc
1802 S Parrott Ave
Okeechobee FL 34974
i ACT
NAME: Sandy Hines
q/�; No, Ext): (863) 763-7711 FAX No):
ADORE
shines ritchardsinc.com
ADDRESS: GAP
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A : OI1IO SECURITY INS CO
24082
INSURED
More 2 Life Ministries Inc
605 Sw Park St
SUITE 214
OKEECHOBEE FL 34972-4173
INSURER B : AUTO OWNERS INS CO
18988
INSURER C : FCBI
11/11/2019
INSURER D :
$ 1,000,000
INSURER E :
$ 1,000.000
INSURER F :
VERAGES
CERTIFICATE NUMBER:
REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE NSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
AIJULUUI1
INSD
WVD
POLICY NUMBER
POLICY EI -F
(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY)
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
Y
BKS58184017
11/11/2018
11/11/2019
EACH OCCURRENCE
$ 1,000,000
DAMAGE I V HEN I EU
PREMISES (Ea occurrence)
$ 1,000.000
CLAIMS -MADE
X
OCCUR
MED EXP (Any one person)
$ 15,000
PERSONAL a ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GEN'L
AGGREGATE
POLICY
OTHER:
LIMIT APPLIES
J
E�X
PER:
LOC
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
13
AUTOMOBILE
X
LIABILITY
ANY AUTO
OWNED
AUTOS ONLY
HIRED
AUTOS ONLY
—
ANON
_
SCHEDULED
AUTOS
-OWNED
AUTOS ONLY
5049898900
10/06/2018
10/06/2019
COMBINED SINGLE LIMI I
(Ea accident)
$ 300,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PHOI'EHIYDAMAGE
(Per accident)
$
$
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
$
DED
RETENTION $
C
WORKERS COMPENSATION
AND EMPLOYERS' LIAI3ILITY
ANY PROPRIETOR/PAFITNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
Y / N
N/A
106-44532
04/01/2018
04/01/2019
X
STATUTE
01H -
EF
E.L. EACH ACCIDENT
$ 100,000
E.L. DISEASE - EA EMPLOYEE
$ 500,000
E.L. DISEASE - POLICY LIMIT
$ 100,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Certificate Holder is Additional Insured in regards to the General Liability form CG8810
CERTIFICATE HOLDER
CANCELLATION
City of Okeechobee
55 SE 3rd Avenue
Okeechobee FL 34974
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
I!_rSRm246 iLl P:4044
es 1.88-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
0000163 12/24/16
Consumer's Certificate of Exemption
Issued Pursuant to Chapter 212, Florida Statutes
FLORIDA
DR -14
R. 10/15
85-80137550160-7
02/28/2017
02/28/2022
501(C)(3) ORGANIZATION
Certificate Number
This certifies that
MORE 2 LIFE MINISTRIES INC
605 SW PARK ST STE 213
OKEECHOBEE FL 34972-4173
Effective Date
Expiration Date
Exemption Category
is exempt from the payment of Florida sales and use tax on real property rented, transient rental property rented, tangible
personal property purchased or rented, or services purchased.
FLORIDA
Important Information for Exempt Organizations
DR -14
R. 10/15
1. You must provide all vendors and suppliers with an exemption certificate before making tax-exempt purchases.
See Ride 12A-1.038._Florida Administrative Code (F.A.C.).
2. Your Consumer's Certificate of Exemption is to be used solely by your organization for your organization's
customary nonprofit activities.
3. Purchases made by an individual on behalf of the organization are taxable, even if the individual will be
reimbursed by the organization.
4. This exemption applies only to purchases your organization makes. The sale or lease to others of tangible
personal property, sleeping accommodations, or other real property is taxable. Your organization must register,
and collect and remit sales and use tax on such taxable transactions.. Note: Churches are exempt from this
requirement except when they are the lessor of real property (Rule 12A-1.070, F.A.C.).
5. It is a criminal offense to fraudulently present this certificate to evade the payment of sales tax. Under no
circumstances should this certificate be used for the personal benefit of any individual. Violators will be liable for
payment of the sales tax plus a penalty of 200% of the tax, and may be subject to conviction of a third-degree
felony. Any violation will require the revocation of this certificate.
6. If you have questions regarding your exemption certificate, please contact the Exemption Unit of Account
Management at 800-352-3671. From the available options, select "Registration of Taxes," then "Registration
Information," and finally "Exemption Certificates and Nonprofit Entities." The mailing address is PO Box 6480,
Tallahassee, FL 32314-6480.
Jackie Dunham
From: Jackie Dunham
Sent: Thursday, May 16, 2019 2:32 PM
To: Chief Herb Smith - City of Okeechobee (Chief Herb Smith); Chief Peterson; David Allen
(dallen@cityofokeechobee.com); Jeffery C. Newell (jnewell@cityofokeechobee.com); Kay
Matchett (kmatchett@cityofokeechobee.com); Kim Barnes (Kim Barnes); Lalo Rodriguez
(Irodriguez@cityofokeechobee.com); Lane Gamiotea
(Igamiotea@cityofokeechobee.com); Major Hagan; Stevie
Cc: Patty Burnette
Subject: Upcoming Park Use Event
Attachments: More 2 Life BBQ Fundraiser.pdf
I am in receipt of a new Park Use Permit from More to Life Ministries. Street closings are NOT requested. I
am attaching a copy for you to review. After you review please stop in General Services to sign and make
comments. Thank you.
Jc ck;,e Dtmnin.a.414/
Acim4,144.1.strcutive'Secretary
City of 0keeto-1
55 SE T1 -d' 4 vevu.tei
Off, EL 34974
863 -763 -3372 (Madvv)
863 -763-9821 (V(ect)
863 -763 -1686 (Fa4c.)
jdunham@cityofokeechobee.com
Website: http://www.cityofokeechobee.com
NOTICE: Due to Florida's broad public laws, this email may be subject to public disclosure.
CITY OF OKEECHOBEE
55 SE THIRD AVENUE
OKEECHOBEE, FL 34974
Tel: 863-763-9821 Fax: 863-763-1686
Website: www.cityofokeechobee.com
NEW CONTRACTOR FORM
Business Name: M, it C C_O V\ -pa O
Business Address: 462(1, 5 .v3 -V C • V
Mailing Address: ilk() IA5 . 1 A -U t✓ .
�
E
City/State: ;lRe,c-Q-e. c beCtc,A. t -LtjfZ.r OPS
Telephone # i54 icy(
Fax# l bf Uo S 3
Cell Phone # ‘4.41661b.0 151 5D-(12 7'6 9 1
/44 Ct it(E CO VA k• A -t
Valid copies of the following must be on file at the City of Okeechobee
Building Department before a permit can be issued.
State and/or applicable License
City or County Business Tax Receipt (County or City where your business
is located)
General Liability Insurance Certificate (City of Okeechobee as holder)
Workers Comp Insurance Certificate (City of Okeechobee as holder)
For more information or any additional questions call our Building
Department at 863-763-9821 or e-mail at jdunham a(�cityofokeechobee.com
Note: Okeechobee County is the licensing agency for the City of Okeechobee. All new contractors
must register with the Okeechobee County Building Department before applying for a permit within the
City. For complete information and instructions contact their office at 863-763-5548.